Two cases of oral squamous cell carcinoma that developed intestinal pneumatosis during radiotherapy combined with selective intra-arterial chemotherapy

Intestinal pneumatosis is a relatively rare disease that causes multilocular or linear cysts with air in the inner wall of the intestine.Surgical treatment is not required when it is not accompanied by intestinal ischemia or necrosis.We report two patients with oral squamous cell carcinoma (SCC) who developed intestinal pneumatosis without surgical treatment during radiotherapy combined with selective intra-arterial chemotherapy (RADPLAT) .They had a history of diabetes.Case 1 involved a 71-year-old man diagnosed with upper gingival SCC (cT4bN2bM0) .We planned R ADPLAT.Mediastinal emphysema was observed during check-up computed tomography (CT) at 20 fractions (20 Fr) .Additionally, pneumatosis was observed in the neck, intestinal tract, and intestinal membrane.Case 2 involved a 76-year-old woman diagnosed with SCC of the left cheek and upper gingiva (cT4bN2cM0) .We planned RADPLAT.A bloody watery stool was observed at 27 Fr.Abdominal CT revealed pneumatosis in the intestinal tract walls of the ileum, ascending colon, and transverse colon.In both cases, we changed enteral alimentation to total parenteral nutrition and reduced the inflammation using antibiotics.Thereafter, continuing chemotherapy was challenging, and only solo radiotherapy was continued.In both cases, intestinal pneumatosis improved at 30-32 Fr; therefore, enteral alimentation was resumed.Radiotherapy was administered as scheduled.